Syria is in the midst of a Measles and Polio epidemic, which is why UNICEF have been fighting to get vaccines into the conflict zone. A fight which has been brought to a halt by a disastrous medical error.
A Shattered Medical system
Syria's civil war has gutted and destroyed its medical care system. Medical facilities are not spared from the onslaught of the civil war. Ambulances and hospitals are often targeted as they retrieve the wounded. Save the Children report that 60% of hospitals have been damaged or destroyed in the fighting. Most of the skilled medical workers have been killed, or forced to flee. Those that stay are overwhelmed, and many lack the skills and training to prop up the countries entire medical system. This is compounded by the lack of resources. The drug manufacturing facilities of Syria have all but shut down, and hospitals often lack crucial resources.
The Rise of an Outbreak
All of these events have added up to an environment that is a boon to pathogens. After 14 years free of Polio, it returned to Syria in October of last year. Measles has also been prospering in the crowded refugee camps, with 7,000 known cases from the current outbreak. This is why organisations such as UNICEF and Medecins Sans Frontieres have been working hard to get vaccines to vulnerable children.
A Disastrous Vaccine Mix Up.
Measles vaccines are supplied as a freeze dried powder. The powder is dissolved in sterile water, allowing it to be put inside a syringe and injected into a patient.
This is where the mix up comes in. Because one bottle of clear liquid looks pretty much like another, it is possible to get confused if you haven't read the labels.
Which may be why some of the vaccines ended up dissolved in Atracurium instead of water. To understand why this is a massive disaster, let me tell you about this drug.
It's often used to weaken muscles, enabling medical procedures like intubation. It's part of a class of molecules called Neuromuscular blockers, such as tubocurarine, and curare. In the right dose, they merely weaken muscles. In high doses , they can be powerful poisons, shutting down the muscles that help you breath, and pump blood around your body.
Using this drug instead of water in the vaccines has proven to be lethal, killing 15 children, and temporarily incapacitating even more. As a result, the vaccination program has been brought to a halt, with some suspecting that these stocks were deliberately sabotaged.
Whilst that is a possibility, it is just as possible that it was a mistake, born of understaffed facilities, inexperienced workers and scant resources. Sterile water may not be as freely available there as it is here, and so many injectable drugs require it that its no wonder that it can go missing. An under-trained and overworked medic may be accidentally reach for a bottle of clear liquid, and can't read the label.
Some may be tempted to draw larger conclusions over vaccine safety, but frankly if that's what you take from this incident, then you are missing the bigger picture. This isn't about the vaccines, its about the huge, unimaginable toll this war has inflicted on its populace. This event is a symptom of a shattered medical system, and medical personnel pushed far beyond their breaking point.